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Fukuda M, Sakai K. 3D porous structure imaging of membranes for medical devices using scanning probe microscopy and electron microscopy: from membrane science points of view. J Artif Organs 2024; 27:83-90. [PMID: 38311666 DOI: 10.1007/s10047-023-01431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 02/06/2024]
Abstract
The evolution of hemodialysis membranes (dialyzer, artificial kidney) was remarkable, since Dow Chemical began manufacturing hollow fiber hemodialyzers in 1968, especially because it involved industrial chemistry, including polymer synthesis and membrane manufacturing process. The development of hemodialysis membranes has brought about the field of medical devices as a major industry. In addition to conventional electron microscopy, scanning probe microscopy (SPM), represented by atomic force microscopy (AFM), has been used in membrane science research on porous membranes for hemodialysis, and membrane science contributes greatly to the hemodialyzer industry. Practical studies of membrane porous structure-function relationship have evolved, and methods for analyzing membrane cross-sectional morphology were developed, such as the ion milling method, which was capable of cutting membrane cross sections on the order of molecular size to obtain smooth surface structures. Recently, following the global pandemic of SARS-CoV-2 infection, many studies on new membranes for extracorporeal membrane oxygenator have been promptly reported, which also utilize membrane science researches. Membrane science is playing a prominent role in membrane-based technologies such as separation and fabrication, for hemodialysis, membrane oxygenator, lithium ion battery separators, lithium recycling, and seawater desalination. These practical studies contribute to the global medical devices industry.
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Affiliation(s)
- Makoto Fukuda
- Department of Biomedical Engineering, Kindai University, 930 Nishimitani, Kinokawa-City, Wakayama, 649-6493, Japan.
| | - Kiyotaka Sakai
- Professor Emeritus of Chemical Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan
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2
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Khurana N, Watkins K, Ghatak D, Staples J, Hubbard O, Yellepeddi V, Watt K, Ghandehari H. Reducing hydrophobic drug adsorption in an in-vitro extracorporeal membrane oxygenation model. Eur J Pharm Biopharm 2024; 198:114261. [PMID: 38490349 DOI: 10.1016/j.ejpb.2024.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving cardiopulmonary bypass technology for critically ill patients with heart and lung failure. Patients treated with ECMO receive a range of drugs that are used to treat underlying diseases and critical illnesses. However, the dosing guidelines for these drugs used in ECMO patients are unclear. Mortality rate for patients on ECMO exceeds 40% partly due to inaccurate dosing information, caused in part by the adsorption of drugs in the ECMO circuit and its components. These drugs range in hydrophobicity, electrostatic interactions, and pharmacokinetics. Propofol is commonly administered to ECMO patients and is known to have high adsorption rates to the circuit components due to its hydrophobicity. To reduce adsorption onto the circuit components, we used micellar block copolymers (Poloxamer 188TM and Poloxamer 407TM) and liposomes tethered with poly(ethylene glycol) to encapsulate propofol, provide a hydrophilic shell and prevent its adsorption. Size, polydispersity index (PDI), and zeta potential of the delivery systems were characterized by dynamic light scattering, and encapsulation efficiency was characterized using High Performance Liquid Chromatography (HPLC). All delivery systems used demonstrated colloidal stability at physiological conditions for seven days, cytocompatibility with a human leukemia monocytic cell line, i.e., THP-1 cells, and did not activate the complement pathway in human plasma. We demonstrated a significant reduction in adsorption of propofol in an in-vitro ECMO model upon encapsulation in micelles and liposomes. These results show promise in reducing the adsorption of hydrophobic drugs to the ECMO circuits by encapsulation in nanoscale structures tethered with hydrophilic polymers on the surface.
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Affiliation(s)
- Nitish Khurana
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kamiya Watkins
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA
| | - Debika Ghatak
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA
| | - Jane Staples
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA
| | - Oliver Hubbard
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Venkata Yellepeddi
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kevin Watt
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hamidreza Ghandehari
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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3
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Zhao Z, Gao W, Chang Y, Yang Y, Shen H, Li T, Zhao S. Asymmetric Triple-Functional Janus Membrane for Blood Oxygenation. Adv Healthc Mater 2024; 13:e2302708. [PMID: 38010837 DOI: 10.1002/adhm.202302708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/18/2023] [Indexed: 11/29/2023]
Abstract
The oxygenation membrane, a core material of extracorporeal membrane oxygenation (ECMO), is facing challenges in balancing anti-plasma leakage, gas exchange efficiency, and hemocompatibility. Here, inspired by the asymmetric structural features of alveolus pulmonalis, a novel triple-functional membrane for blood oxygenation with a Janus architecture is proposed, which is composed of a hydrophobic polydimethylsiloxane (PDMS) layer to prevent plasma leakage, an ultrathin polyamide layer to enhance gas exchange efficiency with a CO2 :O2 permeance ratio of ≈10.7, and a hydrophilic polyzwitterionic layer to improve the hemocompatibility. During the simulated ECMO process, the Janus oxygenation membrane exhibits excellent performance in terms of thrombus formation and plasma leakage prevention, as well as adequate O2 transfer rate (17.8 mL min-1 m-2 ) and CO2 transfer rate (70.1 mL min-1 m-2 ), in comparison to the reported oxygenation membranes. This work presents novel concepts for the advancement of oxygenation membranes and demonstrates the application potential of the asymmetric triple-functional Janus oxygenation membrane in ECMO.
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Affiliation(s)
- Zhenyi Zhao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin Key Laboratory of Membrane Science and Desalination Technology, State Key Laboratory of Chemical Engineering (Tianjin University), Tianjin, 300072, P. R. China
| | - Wenqing Gao
- Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, 300170, P. R. China
| | - Yun Chang
- Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, 300170, P. R. China
| | - Yue Yang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin Key Laboratory of Membrane Science and Desalination Technology, State Key Laboratory of Chemical Engineering (Tianjin University), Tianjin, 300072, P. R. China
| | - Hechen Shen
- Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, 300170, P. R. China
| | - Tong Li
- Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, 300170, P. R. China
| | - Song Zhao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin Key Laboratory of Membrane Science and Desalination Technology, State Key Laboratory of Chemical Engineering (Tianjin University), Tianjin, 300072, P. R. China
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Valenzuela-Faccini N, Poveda-Henao C, Flórez-Navas C, Pérez-Garzón M, Boada-Becerra N, Mercado-Diaz M, Salcedo P, Robayo-Amortegui H. Outcomes of ECMO support with polypropylene membrane during pandemic times: a retrospective cohort study. BMC Pulm Med 2024; 24:41. [PMID: 38243231 PMCID: PMC10797970 DOI: 10.1186/s12890-023-02753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/06/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic resulted in shortages of supplies, which limited the use of extracorporeal membrane oxygenation (ECMO) support. As a contingency strategy, polypropylene (PP) oxygenation membranes were used. This study describes the clinical outcomes in patients on ECMO with PP compared to poly-methylpentene (PMP) oxygenation membranes. METHODS Retrospective cohort of patients in ECMO support admitted between 2020 and 2021. RESULTS A total of 152 patients with ECMO support were included, 71.05% were men with an average age of 42 (SD 9.91) years. Veno-venous configuration was performed in 75.6% of cases. The PP oxygenation membranes required more changes 22 (63.1%), than the PMP Sorin® 24 (32,8%) and Euroset® 15 (31,9%) (p.0.022). The main indication for membrane change was low oxygen transfer for PP at 56.2%, Sorin® at 50%, and Euroset® at 14.8%. Renal replacement therapy was the most frequent complication with PP membrane in 22 patients (68.7%) Sorin® 25 patients (34.2%), and Euroset® 15 patients (31.9%) (p 0.001) without statistically significant differences in mortality. CONCLUSION PP oxygenation membranes was a useful and feasible strategy. It allowed a greater disponibility of ECMO support for critically ill in a situation of great adversity during the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Claudia Poveda-Henao
- Critical Medicine and Intensive Care, Intensive care department Fundación Clínica Shaio, Bogotá DC, Colombia.
- ECMO group Fundación Clínica Shaio Perfusionist intensive care department, Fundación Clínica Shaio, Bogotá DC, Colombia.
| | | | - Michel Pérez-Garzón
- Critical Medicine and Intensive Care, Intensive care department Fundación Clínica Shaio, Bogotá DC, Colombia
- ECMO group Fundación Clínica Shaio Perfusionist intensive care department, Fundación Clínica Shaio, Bogotá DC, Colombia
| | | | - Mario Mercado-Diaz
- Critical Medicine and Intensive Care, Intensive care department Fundación Clínica Shaio, Bogotá DC, Colombia
- ECMO group Fundación Clínica Shaio Perfusionist intensive care department, Fundación Clínica Shaio, Bogotá DC, Colombia
| | - Patricia Salcedo
- ECMO group Fundación Clínica Shaio Perfusionist intensive care department, Fundación Clínica Shaio, Bogotá DC, Colombia
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Li J, He T, Chen H, Cheng Y, Drioli E, Wang Z, Cui Z. Preparation of Hyflon AD/Polypropylene Blend Membrane for Artificial Lung. MEMBRANES 2023; 13:665. [PMID: 37505032 PMCID: PMC10383265 DOI: 10.3390/membranes13070665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023]
Abstract
A high-performance polypropylene hollow fiber membrane (PP-HFM) was prepared by using a binary environmentally friendly solvent of polypropylene as the raw material, adopting the thermally induced phase separation (TIPS) method, and adjusting the raw material ratio. The binary diluents were soybean oil (SO) and acetyl tributyl citrate (ATBC). The suitable SO/ATBC ratio of 7/3 was based on the size change of the L-L phase separation region in PP-SO/ATBC thermodynamic phase diagram. Through the characterization and comparison of the basic performance of PP-HFMs, it was found that with the increase of the diluent content in the raw materials, the micropores of outer surface of the PP-HFM became larger, and the cross section showed a sponge-like pore structure. The fluoropolymer, Hyflon ADx, was deposited on the outer surface of the hollow fiber membrane using a physical modification method of solution dipping. After modification, the surface pore size of the Hyflon AD40L modified membranes decreased; the contact angle increased to around 107°; the surface energy decreased to 17 mN·m-1; and the surface roughness decreased to 17 nm. Hyflon AD40L/PP-HFMs also had more water resistance properties from the variation of wetting curve. For biocompatibility of the membrane, the adsorption capacity of the modified PP membrane for albumin decreased from approximately 1.2 mg·cm-2 to 1.0 mg·cm-2, and the adsorption of platelets decreased under fluorescence microscopy. The decrease in blood cells and protein adsorption in the blood prolonged the clotting time. In addition, the hemolysis rate of modified PP membrane was reduced to within the standard of 5%, and the cell survival rate of its precipitate was above 100%, which also indicated the excellent biocompatibility of fluoropolymer modified membrane. The improvement of hydrophobicity and blood compatibility makes Hyflon AD/PP-HFMs have the potential for application in membrane oxygenators.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, China
- National Engineering Research Center for Special Separation Membrane, Nanjing Tech University, Nanjing 210009, China
| | - Ting He
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, China
- National Engineering Research Center for Special Separation Membrane, Nanjing Tech University, Nanjing 210009, China
| | - Hongyu Chen
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, China
- National Engineering Research Center for Special Separation Membrane, Nanjing Tech University, Nanjing 210009, China
| | - Yangming Cheng
- Jiangsu Aikemo High-Technology Co., Ltd., Suzhou 215000, China
| | - Enrico Drioli
- Research Institute on Membrane Technology, ITM-CNR, Via Pietro Bucci 17/C, 87036 Rende, Italy
| | - Zhaohui Wang
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, China
- National Engineering Research Center for Special Separation Membrane, Nanjing Tech University, Nanjing 210009, China
- Jiangsu Aikemo High-Technology Co., Ltd., Suzhou 215000, China
| | - Zhaoliang Cui
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, China
- National Engineering Research Center for Special Separation Membrane, Nanjing Tech University, Nanjing 210009, China
- Jiangsu Aikemo High-Technology Co., Ltd., Suzhou 215000, China
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6
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Trombino S, Sole R, Curcio F, Cassano R. Polymeric Based Hydrogel Membranes for Biomedical Applications. MEMBRANES 2023; 13:576. [PMID: 37367780 DOI: 10.3390/membranes13060576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
The development of biomedical applications is a transdisciplinary field that in recent years has involved researchers from chemistry, pharmacy, medicine, biology, biophysics, and biomechanical engineering. The fabrication of biomedical devices requires the use of biocompatible materials that do not damage living tissues and have some biomechanical characteristics. The use of polymeric membranes, as materials meeting the above-mentioned requirements, has become increasingly popular in recent years, with outstanding results in tissue engineering, for regeneration and replenishment of tissues constituting internal organs, in wound healing dressings, and in the realization of systems for diagnosis and therapy, through the controlled release of active substances. The biomedical application of hydrogel membranes has had little uptake in the past due to the toxicity of cross-linking agents and to the existing limitations regarding gelation under physiological conditions, but now it is proving to be a very promising field This review presents the important technological innovations that the use of membrane hydrogels has promoted, enabling the resolution of recurrent clinical problems, such as post-transplant rejection crises, haemorrhagic crises due to the adhesion of proteins, bacteria, and platelets on biomedical devices in contact with blood, and poor compliance of patients undergoing long-term drug therapies.
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Affiliation(s)
- Sonia Trombino
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata, 87036 Rende, Italy
| | - Roberta Sole
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata, 87036 Rende, Italy
| | - Federica Curcio
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata, 87036 Rende, Italy
| | - Roberta Cassano
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata, 87036 Rende, Italy
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7
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Khurana N, Sünner T, Hubbard O, Imburgia C, Stoddard GJ, Yellepeddi V, Ghandehari H, Watt KM. Micellar Encapsulation of Propofol Reduces its Adsorption on Extracorporeal Membrane Oxygenator (ECMO) Circuit. AAPS J 2023; 25:52. [PMID: 37225960 DOI: 10.1208/s12248-023-00817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving cardiopulmonary bypass device used on critically ill patients with refractory heart and lung failure. Patients supported with ECMO receive numerous drugs to treat critical illnesses and the underlying diseases. Unfortunately, most drugs prescribed to patients on ECMO lack accurate dosing information. Dosing can be variable in this patient population because the ECMO circuit components can adsorb drugs and affect drug exposure substantially. Propofol is a widely used anesthetic in ECMO patients and is known to have high adsorption rates in ECMO circuits due to its high hydrophobicity. In an attempt to reduce adsorption, we encapsulated propofol with Poloxamer 407 (Polyethylene-Polypropylene Glycol). Size and polydispersity index (PDI) were characterized using dynamic light scattering. Encapsulation efficiency was analyzed using High performance liquid chromatography. Cytocompatibility of micelles was analyzed against human macrophages and the formulation was finally injected in an ex-vivo ECMO circuit to determine the adsorption of propofol. Size and PDI of micellar propofol were 25.5 ± 0.8 nm and 0.08 ± 0.01, respectively. Encapsulation efficiency of the drug was 96.1 ± 1.3%. Micellar propofol demonstrated colloidal stability at physiological temperature for a period of 7 days, and was cytocompatible with human macrophages. Micellar propofol demonstrated a significant reduction in adsorption of propofol in the ECMO circuit at earlier time points compared to free propofol (Diprivan®). We observed 97 ± 2% recovery of the propofol from the micellar formulation after an infusion. These results demonstrate the potential of micellar propofol to reduce drug adsorption to ECMO circuit.
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Affiliation(s)
- Nitish Khurana
- Utah Center for Nanomedicine, Department of Molecular Pharmaceutics, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Till Sünner
- Philipps Universität Marburg, Institut für Pharmazeutische Technologie und Biopharmazie, Marburg, Germany
| | - Oliver Hubbard
- Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - Carina Imburgia
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Gregory J Stoddard
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Venkata Yellepeddi
- Utah Center for Nanomedicine, Department of Molecular Pharmaceutics, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hamidreza Ghandehari
- Utah Center for Nanomedicine, Department of Molecular Pharmaceutics, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Kevin M Watt
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Lustenberger UB, Krestnikova A, Gröninger OG, Grass RN, Stark WJ. Knowledge Transfer in Support of the Development of Oxygen Concentrators in Emergency Settings During the COVID-19 Pandemic. JOURNAL OF CHEMICAL EDUCATION 2023; 100:1858-1865. [PMID: 37552711 PMCID: PMC10176972 DOI: 10.1021/acs.jchemed.2c00925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/13/2023] [Indexed: 08/10/2023]
Abstract
The COVID-19 pandemic simultaneously disrupted supply chains and generated an urgent demand in medical infrastructure. Among personal protective equipment and ventilators, there was also an urgent demand for chemical oxygen. As devices to purify oxygen could not be manufactured and shipped rapidly enough, a simple and accessible oxygen concentrator based on pressure swing adsorption was developed at ETH Zurich in spring 2020. Instead of building devices locally and shipping them, it was decided to educate others in need of oxygen. The implementation encompassed education on process chemistry, material choice, and assembly and optimization of the concentrator and was realized using synchronous teaching tools, such as video call, and asynchronous ones, such as a website and video streaming. The project gained traction and interaction with engineering teams from universities and non-Governmental Organizations (Red Cross and the UN Development Program) in developing countries and emerging market economies, including Ecuador, Mexico, Somalia, and Peru. At the end of the project, the teams were surveyed regarding their experience in the educative knowledge transfer. It was reported that the learning experience prepared these groups well to build the device and to teach others as well. Major challenges were accessing some parts of the device and optimizing its performance. While synchronous communication is expected to be a very effective teaching method, the survey results showed that explanations via a website and video streaming have contributed the most to the implementation of the oxygen concentrator and thereby provide autonomous and sustainable education tools.
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9
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Amoako K, Kaufman R, Haddad WAM, Pusey R, Saniesetty VHK, Sun H, Skoog D, Cook K. Zwitterionic Polysulfobetaine Coating and Antiplatelet Liposomes Reduce Fouling in Artificial Lung Circuits. Macromol Biosci 2023; 23:e2200479. [PMID: 36609882 PMCID: PMC10121813 DOI: 10.1002/mabi.202200479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 01/08/2023]
Abstract
The artificial lung has provided life-saving support for pulmonary disease patients and recently afforded patients with severe cases of COVID-19 better prognostic outcomes. While it addresses a critical medical need, reducing the risk of clotting inside the device remains challenging. Herein, a two-step surface coating process of the lung circuit using Zwitterionic polysulfobetaine methacrylate is evaluated for its nonspecific protein antifouling activity. It is hypothesized that similarly applied coatings on materials integrated (IT) or nonintegrated (NIT) into the circuit will yield similar antifouling activity. The effects of human plasma preconditioned with nitric oxide-loaded liposome on platelet (plt) fouling are also evaluated. Fibrinogen antifouling activities in coated fibers are similar in the IT and NIT groups. It however decreases in coated polycarbonate (PC) in the IT group. Also, plt antifouling activity in coated fibers is similar in the IT and NIT groups and is lower in coated PC and Tygon in the IT group compared to the NIT group. Coating process optimization in the IT lung circuit may help address difference in the coating appearance of outer and inner fiber bundle fibers, and the NO-liposome significantly reduces (86%) plt fouling on fibers indicating its potential use for blood anticoagulation.
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Affiliation(s)
- Kagya Amoako
- Department of Chemistry and Chemical and Biomedical Engineering, Interim Chair, Mechanical and Industrial Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - Rikki Kaufman
- Department of Chemistry and Chemical and Biomedical Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - Waad A M Haddad
- Department of Chemistry and Chemical and Biomedical Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - Romario Pusey
- Department of Chemistry and Chemical and Biomedical Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - Venkata H K Saniesetty
- Department of Chemistry and Chemical and Biomedical Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - Hao Sun
- Department of Chemistry and Chemical and Biomedical Engineering, University of New Haven, West Haven, CT, 06516, USA
| | - David Skoog
- Advanced Respiratory Technologies, LLC, Pittsburgh, PA, 15238, USA
| | - Keith Cook
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
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10
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Strudthoff LJ, Focke J, Hesselmann F, Kaesler A, Martins Costa A, Schlanstein PC, Schmitz-Rode T, Steinseifer U, Steuer NB, Wiegmann B, Arens J, Jansen SV. Novel Size-Variable Dedicated Rodent Oxygenator for ECLS Animal Models-Introduction of the "RatOx" Oxygenator and Preliminary In Vitro Results. MICROMACHINES 2023; 14:800. [PMID: 37421033 DOI: 10.3390/mi14040800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/09/2023]
Abstract
The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator ("RatOx") and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for various rodent models. Gas transfer performances over the fiber module for different blood flows and fiber module sizes were tested according to DIN EN ISO 7199. At the maximum possible amount of effective fiber surface area and a blood flow of 100 mL/min, the oxygenator performance was tested to a maximum of 6.27 mL O2/min and 8.2 mL CO2/min, respectively. The priming volume for the largest fiber module is 5.4 mL, while the smallest possible configuration with a single fiber mat layer has a priming volume of 1.1 mL. The novel RatOx ECLS system has been evaluated in vitro and has demonstrated a high degree of compliance with all pre-defined functional criteria for rodent-sized animal models. We intend for the RatOx to become a standard testing platform for scientific studies on ECLS therapy and technology.
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Affiliation(s)
- Lasse J Strudthoff
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Jannis Focke
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Felix Hesselmann
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Andreas Kaesler
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ana Martins Costa
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Peter C Schlanstein
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Niklas B Steuer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hanover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), 30625 Hanover, Germany
- German Center for Lung Research (DLZ), 30625 Hanover, Germany
| | - Jutta Arens
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Sebastian V Jansen
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
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11
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Guan C, Shen H, Dong S, Zhan Y, Yang J, Zhang Q, Wang R. Research status and development trend of extracorporeal membrane oxygenation based on bibliometrics. Front Cardiovasc Med 2023; 10:1048903. [PMID: 36970366 PMCID: PMC10036781 DOI: 10.3389/fcvm.2023.1048903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundUsing bibliometric method to analyze the research status and development trend of extracorporeal membrane oxygenation (ECMO), we aim to provide clinicians, scientists, and stakeholders with the most up-to-date and comprehensive overview of ECMO research.Materials and methodsUsing Excel and VOSviewer, the literature on ECMO was systematically analyzed regarding publication trends, journal source, foundation, countries, institutions, core authors, research hotspots, and market distribution.ResultsThere were five important time nodes in the research process of ECMO, including the success of the first ECMO operation, the establishment of ELSO, and the outbreak of influenza A/H1N1 and COVID-19. The R&D centers of ECMO were the United States, Germany, Japan, and Italy, and the attention to ECMO was gradually increasing in China. The products most used in the literature were from Maquet, Medtronic, and LivaNova. Medicine enterprises attached great importance to the funding of ECMO research. In recent years, the literature has mainly focused on the following aspects: the treatment of ARDS, the prevention of coagulation system-related complications, the application in neonatal and pediatric patients, mechanical circulatory support for cardiogenic shock, and ECPR and ECMO during the COVID-19 pandemic.ConclusionThe frequent epidemic occurrence of viral pneumonia and the technical advancement of ECMO in recent years have caused an increase in clinical applications. The hot spots of ECMO research are shown in the treatment of ARDS, mechanical circulatory support for cardiogenic shock, and the application during the COVID-19 pandemic.
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Affiliation(s)
- Cuizhong Guan
- Tsinghua University Library, Tsinghua University, Beijing, China
| | - Hua Shen
- Department of Adult Cardiac Surgery, The Sixth Medical Centre of PLA General Hospital, Beijing, China
| | - Shiyong Dong
- Department of Cardiovascular Surgery, The First Medical Centre of PLA General Hospital, Beijing, China
| | - Yuhua Zhan
- Tsinghua University Library, Tsinghua University, Beijing, China
| | - Jie Yang
- Tsinghua University Library, Tsinghua University, Beijing, China
| | - Qiu Zhang
- Tsinghua University Library, Tsinghua University, Beijing, China
- Correspondence: Qiu Zhang Rong Wang
| | - Rong Wang
- Department of Adult Cardiac Surgery, The Sixth Medical Centre of PLA General Hospital, Beijing, China
- Correspondence: Qiu Zhang Rong Wang
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Radu ER, Voicu SI, Thakur VK. Polymeric Membranes for Biomedical Applications. Polymers (Basel) 2023; 15:polym15030619. [PMID: 36771921 PMCID: PMC9919920 DOI: 10.3390/polym15030619] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Polymeric membranes are selective materials used in a wide range of applications that require separation processes, from water filtration and purification to industrial separations. Because of these materials' remarkable properties, namely, selectivity, membranes are also used in a wide range of biomedical applications that require separations. Considering the fact that most organs (apart from the heart and brain) have separation processes associated with the physiological function (kidneys, lungs, intestines, stomach, etc.), technological solutions have been developed to replace the function of these organs with the help of polymer membranes. This review presents the main biomedical applications of polymer membranes, such as hemodialysis (for chronic kidney disease), membrane-based artificial oxygenators (for artificial lung), artificial liver, artificial pancreas, and membranes for osseointegration and drug delivery systems based on membranes.
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Affiliation(s)
- Elena Ruxandra Radu
- Department of Analytical Chemistry and Environmental Engineering, University Politehnica of Bucharest, 011061 Bucharest, Romania
- Advanced Polymers Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania
| | - Stefan Ioan Voicu
- Department of Analytical Chemistry and Environmental Engineering, University Politehnica of Bucharest, 011061 Bucharest, Romania
- Advanced Polymers Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania
- Correspondence: (S.I.V.); (V.K.T.)
| | - Vijay Kumar Thakur
- Biorefining and Advanced Materials Research Center, Scotland’s Rural College (SRUC), Kings Buildings, Edinburgh EH9 3JG, UK
- School of Engineering, University of Petroleum & Energy Studies (UPES), Dehradun 248007, Uttarakhand, India
- Centre for Research & Development, Chandigarh University, Mohali 140413, Punjab, India
- Correspondence: (S.I.V.); (V.K.T.)
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13
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Bölükbas DA, Tas S. Current and Future Engineering Strategies for ECMO Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1413:313-326. [PMID: 37195538 DOI: 10.1007/978-3-031-26625-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a last resort therapy for patients with respiratory failure where the gas exchange capacity of the lung is compromised. Venous blood is pumped through an oxygenation unit outside of the body where oxygen diffusion into the blood takes place in parallel to carbon dioxide removal. ECMO is an expensive therapy which requires special expertise to perform. Since its inception, ECMO technologies have been evolving to improve its success and minimize the complications associated with it. These approaches aim for a more compatible circuit design capable of maximum gas exchange with minimal need for anticoagulants. This chapter summarizes the basic principles of ECMO therapy with the latest advancements and experimental strategies aiming for more efficient future designs.
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Affiliation(s)
- Deniz A Bölükbas
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Sinem Tas
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden
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14
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Cao D, Ding J. Recent advances in regenerative biomaterials. Regen Biomater 2022; 9:rbac098. [PMID: 36518879 PMCID: PMC9745784 DOI: 10.1093/rb/rbac098] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 07/22/2023] Open
Abstract
Nowadays, biomaterials have evolved from the inert supports or functional substitutes to the bioactive materials able to trigger or promote the regenerative potential of tissues. The interdisciplinary progress has broadened the definition of 'biomaterials', and a typical new insight is the concept of tissue induction biomaterials. The term 'regenerative biomaterials' and thus the contents of this article are relevant to yet beyond tissue induction biomaterials. This review summarizes the recent progress of medical materials including metals, ceramics, hydrogels, other polymers and bio-derived materials. As the application aspects are concerned, this article introduces regenerative biomaterials for bone and cartilage regeneration, cardiovascular repair, 3D bioprinting, wound healing and medical cosmetology. Cell-biomaterial interactions are highlighted. Since the global pandemic of coronavirus disease 2019, the review particularly mentions biomaterials for public health emergency. In the last section, perspectives are suggested: (i) creation of new materials is the source of innovation; (ii) modification of existing materials is an effective strategy for performance improvement; (iii) biomaterial degradation and tissue regeneration are required to be harmonious with each other; (iv) host responses can significantly influence the clinical outcomes; (v) the long-term outcomes should be paid more attention to; (vi) the noninvasive approaches for monitoring in vivo dynamic evolution are required to be developed; (vii) public health emergencies call for more research and development of biomaterials; and (viii) clinical translation needs to be pushed forward in a full-chain way. In the future, more new insights are expected to be shed into the brilliant field-regenerative biomaterials.
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Affiliation(s)
- Dinglingge Cao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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15
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Hemocompatibility challenge of membrane oxygenator for artificial lung technology. Acta Biomater 2022; 152:19-46. [PMID: 36089235 DOI: 10.1016/j.actbio.2022.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
The artificial lung (AL) technology is one of the membrane-based artificial organs that partly augments lung functions, i.e. blood oxygenation and CO2 removal. It is generally employed as an extracorporeal membrane oxygenation (ECMO) device to treat acute and chronic lung-failure patients, and the recent outbreak of the COVID-19 pandemic has re-emphasized the importance of this technology. The principal component in AL is the polymeric membrane oxygenator that facilitates the O2/CO2 exchange with the blood. Despite the considerable improvement in anti-thrombogenic biomaterials in other applications (e.g., stents), AL research has not advanced at the same rate. This is partly because AL research requires interdisciplinary knowledge in biomaterials and membrane technology. Some of the promising biomaterials with reasonable hemocompatibility - such as emerging fluoropolymers of extremely low surface energy - must first be fabricated into membranes to exhibit effective gas exchange performance. As AL membranes must also demonstrate high hemocompatibility in tandem, it is essential to test the membranes using in-vitro hemocompatibility experiments before in-vivo test. Hence, it is vital to have a reliable in-vitro experimental protocol that can be reasonably correlated with the in-vivo results. However, current in-vitro AL studies are unsystematic to allow a consistent comparison with in-vivo results. More specifically, current literature on AL biomaterial in-vitro hemocompatibility data are not quantitatively comparable due to the use of unstandardized and unreliable protocols. Such a wide gap has been the main bottleneck in the improvement of AL research, preventing promising biomaterials from reaching clinical trials. This review summarizes the current state-of-the-art and status of AL technology from membrane researcher perspectives. Particularly, most of the reported in-vitro experiments to assess AL membrane hemocompatibility are compiled and critically compared to suggest the most reliable method suitable for AL biomaterial research. Also, a brief review of current approaches to improve AL hemocompatibility is summarized. STATEMENT OF SIGNIFICANCE: The importance of Artificial Lung (AL) technology has been re-emphasized in the time of the COVID-19 pandemic. The utmost bottleneck in the current AL technology is the poor hemocompatibility of the polymer membrane used for O2/CO2 gas exchange, limiting its use in the long-term. Unfortunately, most of the in-vitro AL experiments are unsystematic, irreproducible, and unreliable. There are no standardized in-vitro hemocompatibility characterization protocols for quantitative comparison between AL biomaterials. In this review, we tackled this bottleneck by compiling the scattered in-vitro data and suggesting the most suitable experimental protocol to obtain reliable and comparable hemocompatibility results. To the best of our knowledge, this is the first review paper focusing on the hemocompatibility challenge of AL technology.
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Feng Y, Wang Q, Zhi L, Sun S, Zhao C. Anticoagulant biomimetic consecutive gas exchange network for advanced artificial lung membrane. J Memb Sci 2022. [DOI: 10.1016/j.memsci.2022.120502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Membranes for extracorporeal membrane oxygenator (ECMO): history, preparation, modification and mass transfer. Chin J Chem Eng 2022. [DOI: 10.1016/j.cjche.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Astor TL, Borenstein JT. The microfluidic artificial lung: Mimicking nature's blood path design to solve the biocompatibility paradox. Artif Organs 2022; 46:1227-1239. [PMID: 35514275 DOI: 10.1111/aor.14266] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
The increasing prevalence of chronic lung disease worldwide, combined with the emergence of multiple pandemics arising from respiratory viruses over the past century, highlights the need for safer and efficacious means for providing artificial lung support. Mechanical ventilation is currently used for the vast majority of patients suffering from acute and chronic lung failure, but risks further injury or infection to the patient's already compromised lung function. Extracorporeal membrane oxygenation (ECMO) has emerged as a means of providing direct gas exchange with the blood, but limited access to the technology and the complexity of the blood circuit have prevented the broader expansion of its use. A promising avenue toward simplifying and minimizing complications arising from the blood circuit, microfluidics-based artificial organ support, has emerged over the past decade as an opportunity to overcome many of the fundamental limitations of the current standard for ECMO cartridges, hollow fiber membrane oxygenators. The power of microfluidics technology for this application stems from its ability to recapitulate key aspects of physiological microcirculation, including the small dimensions of blood vessel structures and gas transfer membranes. An even greater advantage of microfluidics, the ability to configure blood flow patterns that mimic the smooth, branching nature of vascular networks, holds the potential to reduce the incidence of clotting and bleeding and to minimize reliance on anticoagulants. Here, we summarize recent progress and address future directions and goals for this potentially transformative approach to artificial lung support.
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Affiliation(s)
- Todd L Astor
- Biomembretics, Inc., Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Golbaten-Mofrad H, Salehi MH, Jafari SH, Goodarzi V, Entezari M, Hashemi M. Preparation and properties investigation of biodegradable poly (glycerol sebacate-co-gelatin) containing nanoclay and graphene oxide for soft tissue engineering applications. J Biomed Mater Res B Appl Biomater 2022; 110:2241-2257. [PMID: 35467798 DOI: 10.1002/jbm.b.35073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
This study has attempted to systematically investigate the influence of nanoclay and graphene oxide (GO) on thermal, mechanical, hydrophobic, and, most importantly, biological properties of poly(glycerol sebacate)/gelatin (PGS/gel) nanocomposites. The PGS/gel copolymer nanocomposites were successfully synthesized via in situ polymerization, approved by rudimentary characterization methods. The nanofillers were appropriately dispersed within the elastomeric matrix according to morphological studies. Also, the fillers posed as a hydrophobic entity that slightly decreased the hydrophilic properties of PGS/gel. This could be sensed clearly in hybrid composite due to the robust network of GO and clay. Water contact angle values for gelatin-contained nanocomposites were reported in the range of 38.42° to 66.7°, indicating the hydrophilic nature of the prepared samples. Thermal and mechanical studies of nanocomposites displayed rather contradicting results as the former improved while a slight decrease in the latter was noticed compared to the pristine specimens. In dry conditions, their storage modulus was in the range of 0.94-6.4 MPa, making them suitable for mimicking some soft tissues. The swelling ratio for nanocomposites containing nanoparticles was associated with an ascending trend so that GO improved the swelling rate by up to 45%. Biological analyses, such as Ames and in vitro cell viability tests, exhibited promising outcomes. As for the mutagenesis effect, the PGS and hybrid samples showed negative results. The presence of functional groups on the nanofillers' surface positively influenced the cells' metabolic activity as well as its attachment to the matrix. After 7 days, the cell proliferation rate resulted in an 82% improvement for the GO-containing nanocomposite, significantly higher than its neat counterpart (65%). This study has shown the feasibility of the prepared bio-elastomer nanocomposites for diverse tissue engineering applications.
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Affiliation(s)
- Hooman Golbaten-Mofrad
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Hadi Salehi
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Seyed Hassan Jafari
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Vahabodin Goodarzi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maliheh Entezari
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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20
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Gomez F, Veita J, Laudanski K. Antibiotics and ECMO in the Adult Population—Persistent Challenges and Practical Guides. Antibiotics (Basel) 2022; 11:antibiotics11030338. [PMID: 35326801 PMCID: PMC8944696 DOI: 10.3390/antibiotics11030338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an emerging treatment modality associated with a high frequency of antibiotic use. However, several covariables emerge during ECMO implementation, potentially jeopardizing the success of antimicrobial therapy. These variables include but are not limited to: the increased volume of distribution, altered clearance, and adsorption into circuit components, in addition to complex interactions of antibiotics in critical care illness. Furthermore, ECMO complicates the assessment of antibiotic effectiveness as fever, or other signs may not be easily detected, the immunogenicity of the circuit affects procalcitonin levels and other inflammatory markers while disrupting the immune system. We provided a review of pharmacokinetics and pharmacodynamics during ECMO, emphasizing practical application and review of patient-, illness-, and ECMO hardware-related factors.
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Affiliation(s)
- Francisco Gomez
- Department of Neurology, University of Missouri, Columbia, MO 65021, USA;
| | - Jesyree Veita
- Society for Healthcare Innovation, Philadelphia, PA 19146, USA;
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19146, USA
- Leonard Davis Institute for HealthCare Economics, University of Pennsylvania, Philadelphia, PA 19146, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19146, USA
- Correspondence: ; Tel.: +1-215-6628200
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21
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Pieri M, Quaggiotti L, Fominskiy E, Landoni G, Calabrò MG, Ajello S, Bonizzoni MA, Scandroglio AM. Anticoagulation strategies in critically-ill SARS-CoV-2 patients: the role of direct thrombin inhibitors. J Cardiothorac Vasc Anesth 2022; 36:2961-2967. [PMID: 35428549 PMCID: PMC8902052 DOI: 10.1053/j.jvca.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design An observational study. Setting At the intensive care unit of a university hospital. Participants and Interventions Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin. Measurements and Main Results Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08). Conclusions Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.
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22
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Chen PH, Iun CP, Tsai JC, Tang M. Grafting of 2-Hydroxyethyl Methacrylate onto Polyacrylonitrile Using Supercritical Carbon Dioxide. J Supercrit Fluids 2022. [DOI: 10.1016/j.supflu.2022.105589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Ran F, Li C, Hao Z, Zhang X, Dai L, Si C, Shen Z, Qiu Z, Wang J. Combined bactericidal process of lignin and silver in a hybrid nanoparticle on E. coli. ADVANCED COMPOSITES AND HYBRID MATERIALS 2022; 5:1841-1851. [PMID: 35434523 PMCID: PMC9002214 DOI: 10.1007/s42114-022-00460-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 05/12/2023]
Abstract
UNLABELLED Among multiple engineered nanoparticles that have been used in the bactericidal application, silver nanoparticles (Ag NPs) are the most explored bactericidal functional materials with their high efficiency and broad-spectrum bactericidal properties. However, environmental toxicology and lack of modifiability restrict their further development. In this study, a simple and economic method was established to fabricate lignin and silver hybrid nanoparticles (Lig-Ag NPs) with bactericidal ability. Afterwards, material characterization, bactericidal evaluation, and mechanism exploration were implemented to explore the properties of Lig-Ag NPs. The results indicated that Lig-Ag NPs not only demonstrated remarkable dispersity, uniformity, and encapsulation efficiency but also possessed approximated bactericidal ability on Escherichia coli and better durability compared with the same concentration of Ag NPs on E. coli. On the other hand, flow cytometry and transcriptomic analysis were used to further explore the bactericidal mechanism of Lig-Ag NPs. The results showed that oxidative stress was the possible leading bactericidal mechanism of Lig-Ag NPs. The formation approaches of reactive oxygen species production were various including the slow release of silver ion and generation of quinone/semi-quinone radicals on account of the combined effect of lignin and silver. GRAPHICAL ABSTRACT Lig-Ag NPs exhibited remarkable dispersity, uniformity, encapsulation efficiency, and possessed approximated bactericidal ability and better durability compared with Ag NPs. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s42114-022-00460-z.
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Affiliation(s)
- Fangli Ran
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
| | - Chenyu Li
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
| | - Zhenxin Hao
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
| | - Xinyuan Zhang
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
| | - Lin Dai
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
| | - Chuanling Si
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
| | - Zhiqiang Shen
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
| | - Zhigang Qiu
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
| | - Jingfeng Wang
- Department of Environment and Health, Tianjin Institute of Environmental and Operational Medicine, Tianjin, 300050 People’s Republic of China
- Tianjin Key Laboratory of Pulp and Paper, College of Light Industry and Engineering, Tianjin University of Science and Technology, Tianjin, 300457 People’s Republic of China
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Towards Biohybrid Lung Development-Fibronectin-Coating Bestows Hemocompatibility of Gas Exchange Hollow Fiber Membranes by Improving Flow-Resistant Endothelialization. MEMBRANES 2021; 12:membranes12010035. [PMID: 35054561 PMCID: PMC8779364 DOI: 10.3390/membranes12010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 01/26/2023]
Abstract
To provide an alternative treatment option for patients with end-stage lung disease, we aim for biohybrid lung development (BHL) based on hollow fiber membrane (HFM) technology used in extracorporeal membrane oxygenators. For long-term BHL application, complete hemocompatibility of all blood-contacting surfaces is indispensable and can be achieved by their endothelialization. Indeed, albumin/heparin (AH) coated HFM enables initial endothelialization, but as inexplicable cell loss under flow conditions was seen, we assessed an alternative HFM coating using fibronectin (FN). Therefore, endothelial cell (EC) adherence and viability on both coated HFM were analyzed by fluorescence-based staining. Functional leukocyte and thrombocyte adhesion assays were performed to evaluate hemocompatibility, also in comparison to blood plasma coated HFM as a clinically relevant control. To assess monolayer resistance and EC behavior under clinically relevant flow conditions, a mock circulation setup was established, which also facilitates imitation of lung-disease specific blood gas settings. Besides quantification of flow-associated cell loss, endothelial responses towards external stimuli, like flow exposure or TNFα stimulation, were analyzed by qRT-PCR, focusing on inflammation, thrombus formation and extracellular matrix production. Under static conditions, both coated HFM enabled the generation of a viable, confluent, non-inflammatory and anti-thrombogenic monolayer. However, by means of homogenous FN coating, cell retention and physiologic gene regulation towards an improved hemocompatible-and extracellular matrix producing phenotype, was significantly superior compared to the inhomogeneous AH coating. In summary, our adaptable in-house FN coating secures the endothelial requirements for long-term BHL application and may promote monolayer establishment on all other blood contacting surfaces of the BHL (e.g., cannulae).
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Towards Biohybrid Lung: Induced Pluripotent Stem Cell Derived Endothelial Cells as Clinically Relevant Cell Source for Biologization. MICROMACHINES 2021; 12:mi12080981. [PMID: 34442603 PMCID: PMC8401467 DOI: 10.3390/mi12080981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
In order to provide an alternative treatment option to lung transplantation for patients with end-stage lung disease, we aim for the development of an implantable biohybrid lung (BHL), based on hollow fiber membrane (HFM) technology used in extracorporeal membrane oxygenators. Complete hemocompatibility of all blood contacting surfaces is crucial for long-lasting BHL durability and can be achieved by their endothelialization. Autologous endothelial cells (ECs) would be the ideal cell source, but their limited proliferation potential excludes them for this purpose. As induced pluripotent stem cell-derived ECs enable the generation of a large number of ECs, we assessed and compared their capacity to form a viable and confluent monolayer on HFM, while indicating physiologic EC-specific anti-thrombogenic and anti-inflammatory properties. ECs were generated from three different human iPSC lines, and seeded onto fibronectin-coated poly-4-methyl-1-pentene (PMP) HFM. Following phenotypical characterization, ECs were analyzed for their thrombogenic and inflammatory behavior with or without TNFα induction, using FACS and qRT-PCR. Complementary, leukocyte- and platelet adhesion assays were carried out. The capacity of the iPSC-ECs to reendothelialize cell-free monolayer areas was assessed in a scratch assay. ECs sourced from umbilical cord blood (hCBECs) were used as control. iPSC-derived ECs formed confluent monolayers on the HFM and showed the typical EC-phenotype by expression of VE-cadherin and collagen-IV. A low protein and gene expression level of E-selectin and tissue factor was detected for all iPSC-ECs and the hCBECs, while a strong upregulation of these markers was noted upon stimulation with TNFα. This was in line with the physiological and strong induction of leukocyte adhesion detected after treatment with TNFα, iPSC-EC and hCBEC monolayers were capable of reducing thrombocyte adhesion and repopulating scratched areas. iPSCs offer the possibility to provide patient-specific ECs in abundant numbers needed to cover all blood contacting surfaces of the BHL with a viable, non-thrombogenic and non-inflammatory monolayer. iPSC-EC clones can differ in terms of their reendothelialization rate, and pro-inflammatory response. However, a less profound inflammatory response may even be advantageous for BHL application. With the proven ability of the seeded iPSC-ECs to reduce thrombocyte adhesion, we expect that thrombotic events that could lead to BHL occlusion can be avoided, and thus, justifies further studies on enabling BHL long-term application.
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Willers A, Arens J, Mariani S, Pels H, Maessen JG, Hackeng TM, Lorusso R, Swol J. New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices. MEMBRANES 2021; 11:membranes11080617. [PMID: 34436380 PMCID: PMC8399034 DOI: 10.3390/membranes11080617] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022]
Abstract
The use of extracorporeal life support (ECLS) devices has significantly increased in the last decades. Despite medical and technological advancements, a main challenge in the ECLS field remains the complex interaction between the human body, blood, and artificial materials. Indeed, blood exposure to artificial surfaces generates an unbalanced activation of the coagulation cascade, leading to hemorrhagic and thrombotic events. Over time, several anticoagulation and coatings methods have been introduced to address this problem. This narrative review summarizes trends, advantages, and disadvantages of anticoagulation and coating methods used in the ECLS field. Evidence was collected through a PubMed search and reference scanning. A group of experts was convened to openly discuss the retrieved references. Clinical practice in ECLS is still based on the large use of unfractionated heparin and, as an alternative in case of contraindications, nafamostat mesilate, bivalirudin, and argatroban. Other anticoagulation methods are under investigation, but none is about to enter the clinical routine. From an engineering point of view, material modifications have focused on commercially available biomimetic and biopassive surfaces and on the development of endothelialized surfaces. Biocompatible and bio-hybrid materials not requiring combined systemic anticoagulation should be the future goal, but intense efforts are still required to fulfill this purpose.
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Affiliation(s)
- Anne Willers
- ECLS Centre, Cardio-Thoracic Surgery, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (S.M.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands;
- Correspondence: (A.W.); (J.S.); Tel.: +31-(0)649-07-9752 (A.W.); +49-(911)-398-0 (J.S.)
| | - Jutta Arens
- Engineering Organ Support Technologies Group, Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (J.A.); (H.P.)
| | - Silvia Mariani
- ECLS Centre, Cardio-Thoracic Surgery, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (S.M.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands;
| | - Helena Pels
- Engineering Organ Support Technologies Group, Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (J.A.); (H.P.)
| | - Jos G. Maessen
- ECLS Centre, Cardio-Thoracic Surgery, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (S.M.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands;
| | - Tilman M. Hackeng
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands;
- Department of Biochemistry, Faculty of Health, Medicine and Life, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Roberto Lorusso
- ECLS Centre, Cardio-Thoracic Surgery, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (S.M.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands;
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Ernst-Nathan Str. 1, 90419 Nuremberg, Germany
- Correspondence: (A.W.); (J.S.); Tel.: +31-(0)649-07-9752 (A.W.); +49-(911)-398-0 (J.S.)
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Applying a Hydrophilic Modified Hollow Fiber Membrane to Reduce Fouling in Artificial Lungs. SEPARATIONS 2021. [DOI: 10.3390/separations8080113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Membranes for use in high gas exchange lung applications are riddled with fouling. The goal of this research is to create a membrane that can function in an artificial lung until the actual lung becomes available for the patient. The design of the artificial lung is based on new hollow fiber membranes (HFMs), due to which the current devices have short and limited periods of low fouling. By successfully modifying membranes with attached peptoids, low fouling can be achieved for longer periods of time. Hydrophilic modification of porous polysulfone (PSF) membranes can be achieved gradually by polydopamine (PSU-PDA) and peptoid (PSU-PDA-NMEG5). Polysulfone (PSU-BSA-35Mg), polysulfone polydopamine (PSUPDA-BSA-35Mg) and polysulfone polydopamine peptoid (PSU-PDA-NMEG5-BSA35Mg) were tested by potting into the new design of gas exchange modules. Both surfaces of the modified membranes were found to be highly resistant to protein fouling permanently. The use of different peptoids can facilitate optimization of the low fouling on the membrane surface, thereby allowing membranes to be run for significantly longer time periods than has been currently achieved.
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